I just finished writing a blow by blow description of my Uncle Stan, age 94, falling in his apartment and breaking his left hip. I hate what I wrote. I don’t have the writing ability to keep your attention while describing all the running around I was doing accompanied by intense wildly vacillating emotions. Some writers can grab you and put you in their shoes so that you feel the sadness, the anger, the helplessness of being the caretaker of someone who has been vital and in charge his entire life. I had hoped the writing would push me to sort through a lot of my questions of American versus French medical systems as I’m at the age where I’m asking myself “Where do I want to grow old?”
I’m writing all this from my little desk in Paris. I returned here over the weekend feeling no small amount of guilt for leaving Stan in the hands of Skilled Nursing. These are the things that have stuck to me and won’t let go. Stan was so miserable, so uncomfortable, so humiliated by his powerlessness that he sank into depression and confessed that he wanted to die. I couldn’t find any fault with that thinking. The surgeons couldn’t do a hip surgery on him, he was too old. They opted for two one-inch incisions at his left hip and placing small rods in to hold the hip together. Then it was up to him to do Physical Therapy to strengthen himself enough to be able to walk again. What I saw in front of me was an old man who was so thin, so small that he looked like a little boy lost in his twin size bed. A man whose lack of any fat on him caused him to slip far down in his wheel chair until he became so unbearably uncomfortable that I’d go looking for aides to help pull him up again. His hearing is so bad that even with his hearing aids, we had to almost yell to explain to him what was happening. Due to another syndrome, his hands and feet got little circulation and he was cold most of the time. I would wrap his Princeton stadium blanket around him as if he was a baby in a casket. It wasn’t difficult at all to step into his slippers and think “I don’t want to live like this.” He was completely helpless, dependent on me and the nursing staff. He stopped eating. He said he had no appetite, that this was the first symptom that Enid had (his wife who died six years ago) when she was sick with pancreatic cancer. He convinced one of the nurses to include a blood test for pancreatic cancer in his lab work. I knew that he was saying “I just want to die.”
The Skilled Nursing unit of Stan’s Continuing Care Retirement Community was understaffed and underpaid. I know they were working hard. But they couldn’t be everywhere at once. Sometimes when Stan pushed his call button, it would take 15 to 20 minutes before someone came in. Stan has a primary doctor in Princeton but none of the staff could take orders from her. They could consult with her. After the first day back at Skilled Nursing, I didn’t hear about any consulting. It seemed the right hand didn’t know what the left hand was doing. When I mentioned this to any friends, they would nod knowingly as if this was an accepted fact of the American system. Without an advocate, a person could easily be forgotten. Especially someone like Stan who doesn’t like to make waves because he’s embarrassed to be seen as he is. He made it clear he didn’t want any visitors. We had to cook up a plan to encourage his friends to visit as if they were just passing by but not stay too long as it tired him too much. No way were we going to leave Stan along with his depression.
By the time I left late Friday, the staff was going to put him on an IV to feed him. My cousin, Joan, was there expertly taking over the reins to insure that Stan didn’t get lost in the system. She wrote to say that the visits were cheering him up a bit. Though it was only mentioned a couple of times to me, I couldn’t help but think that so much of this mess is due to our lousy Insurance system. It was strongly hinted that he left the hospital too soon because insurance/medicare would pay another night. When he wanted the extra lab work, a nurse took me aside and said that insurance may not pay for it. The underpaid overworked staff remain so in order to line the pockets of those at the top of the Insurance Food chain. I’ve had the experience of having to pay more for a medicine with my Co-Pay than the entire cost is here in Paris. This is, of course, just my opinion but as I watched the week with Stan unfold, it struck me that this is one of the ways the Insurance men and laws deal with our elders–hide them and maybe they’ll go faster. I don’t feel polite about my dealings with the health care system last week. I made myself unlikeable to all the staff, sometimes even to me. But what would have happened to Stan if I hadn’t been there? It was Thanksgiving week and people were on vacation.